Provider Demographics
NPI:1316040900
Name:MOORE CHIROPRACTIC PC
Entity Type:Organization
Organization Name:MOORE CHIROPRACTIC PC
Other - Org Name:DEEMER CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:CARL
Authorized Official - Last Name:DEEMER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:405-688-0088
Mailing Address - Street 1:7709 S PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73159
Mailing Address - Country:US
Mailing Address - Phone:405-688-0088
Mailing Address - Fax:405-688-0089
Practice Address - Street 1:7709 S PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73159
Practice Address - Country:US
Practice Address - Phone:405-688-0088
Practice Address - Fax:405-688-0089
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-07
Last Update Date:2007-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3397111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
U68478Medicare UPIN